Pregnancy: CNS complications

Kerry Hulsing MD (Dr. Hulsing of the University of Michigan Medical School has no relevant financial relationships to disclose. Dr. Hulsing's spouse has received consulting fees from GlaxoSmithKline and UCB Pharma.)
James G Greene MD PhD, editor. (Dr. Greene of Emory University School of Medicine has no relevant financial relationships to disclose.)
Originally released February 2, 2000; last updated September 29, 2009; expires September 29, 2012
Notice: This article has expired and is therefore not available for CME credit.

This article includes discussion of pregnancy: CNS complications, cerebral phlebothrombosis, and toxemia of pregnancy. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Given the acuity of possible outcomes, as well as the added clinical dimension of an unborn child, the pregnant patient can prove to be a particular challenge for the treating neurologist. As well, the postpartum period carries with it significant and unique neurologic risks. In this article, the author reviews the common central neurologic complications seen in pregnancy and the postpartum period. The key presenting features of eclampsia are discussed as well as ischemic and hemorrhagic cerebrovascular events.

Historical note and terminology

The physiologic changes that occur during pregnancy and the puerperium can adversely affect the central nervous system and complicate the management of preexisting neurologic conditions. The effect of pregnancy on chronic neurologic conditions such as epilepsy, multiple sclerosis, myasthenia gravis, and migraine will not be discussed here. Diagnosis and management of the central nervous system disorders that can develop during pregnancy will be specifically addressed. Eclampsia is reviewed in this article, and it is also covered as an individual article.

Central neurologic complications associated with pregnancy are well recognized and described throughout history. In 1888 Sir William Gowers described severe convulsions in women with hypertension, proteinuria, and edema. This clinical syndrome, known as eclampsia or toxemia of pregnancy, is a unique disease associated with pregnancy-induced hypertension. Cerebrovascular events were also prominent causes of maternal morbidity and mortality. In 1899 Edward Lazard described the first intracerebral hemorrhage in pregnancy, noted at autopsy to be the result of a ruptured aneurysm. John Abercrombie made the first autopsy description of puerperal cerebral phlebothrombosis in 1828; however, the clinical syndrome of central venous thrombosis was not described until Gowers in 1893.

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